Patients, physicians, nurses, employers, payers, and other players in the health care system are directly affected by the severe limitations of the current US health care delivery and reimbursement system. The future will be worse unless the root causes of this dysfunction are addressed. The symptoms are fairly clear and the data to support a diagnosis as well as potential therapeutic options are available.

Unwarranted variation1 in the delivery of care contributes to the lack of a relationship between what is spent on health care and the quality of the services delivered.2 Other countries that spend far less per capita on health care than the United States deliver care that is more equitable, effective, and efficient and is safer and more patient-centered than is provided in the United States.3,4 The United States is slipping further behind other countries in areas such as amenable mortality5 and ranks poorly compared with several other countries on important attributes such as access and safety.4 Research suggests that the presence and support of a robust primary care system is a major characteristic of an efficient and high-quality health care delivery. This has been demonstrated in other countries as well as in the United States.6